title: Invasive fungal infections: epidemiology and analysis of antifungal prescriptions in onco-haematology.
abstract: OBJECTIVE
  Invasive fungal infections (IFI) are associated with high rates of morbidity and mortality, particularly in onco-haematology patients. We aimed to study the epidemiology of IFI in neutropenic patients and estimate the economic impact of treatment of those infections.
  
  
  METHODS
  All patients hospitalized in onco-haematology, and treated with antifungal agents, in 2005 were investigated. Four features were studied: the diagnosis for each patient, the antifungal drugs used, the thoracic densitometry reports and the sero-mycological data. Infectious episodes were stratified according to the EORTC 2008 classification criteria (10).
  
  
  CONCLUSIONS
  Of the 1130 patients surveyed, 192 patients received systemic antifungal agents. Of these 46% had acute leukaemia, 29% bone-marrow allografts, 7% lymphoma and 18% other malignant haemopathies. Using the EORTC 2008 criteria (10), there were 8 proved IFI (3 aspergillosis, 3 candidosis and 2 other IFI), 17 probable IFI (11 aspergillosis, 6 candidosis) and 16 possible aspergillosis. The incidence of IFI was 2·1%. Eighty patients (41·7%) had received prophylaxis: 56 with fluconazole and 24 with voriconazole. Treatment was most often empirical (n = 127, 66·1%). Combination of two antifungals was used in 17 cases. The mean duration of prophylactic, empirical, proved/probable aspergillosis-directed, candidaemia-directed and combination treatment was 19, 19, 46, 32 and 27 days, respectively. The cost of antifungal treatment in 2005 reached almost 2,000,000 €, including 427,000 € for documented infections (proved and probable), 1,246,000 € for empirical treatment and 58,300 € for prophylaxis.
  
  
  CONCLUSIONS
  The incidence of IFI is low but the pharmacoeconomic impact is extremely high. Improved strategies are required to reduce the frequency and duration of empirical treatment without compromising beneficial outcome.
authors.affiliation: Pharmacy Department, Lille University Hospital, Tourcoing Hospital, Lille, France.
authors.forename: B
authors.initials: B
authors.lastname: des Champs-Bro
authors.forename: A
authors.initials: A
authors.lastname: Leroy-Cotteau
authors.forename: F
authors.initials: F
authors.lastname: Mazingue
authors.forename: F
authors.initials: F
authors.lastname: Pasquier
authors.forename: N
authors.initials: N
authors.lastname: François
authors.forename: S
authors.initials: S
authors.lastname: Corm
authors.forename: L
authors.initials: L
authors.lastname: Lemaitre
authors.forename: D
authors.initials: D
authors.lastname: Poulain
authors.forename: I
authors.initials: I
authors.lastname: Yakoub-Agha
authors.forename: S
authors.initials: S
authors.lastname: Alfandari
authors.forename: B
authors.initials: B
authors.lastname: Sendid
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D018450:Disease Progression; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D009181:Mycoses / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D009503:Neutropenia / Q000150:complications; D055553:Prescription Drugs / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D055553:Prescription Drugs